Shame: Secret Ally of Illness (cont.)

The effects of shame and stigma can be devastating to a person's health, experts tell WebMD. They're seen not only in people with life-altering medical problems but also in relatively healthy people with risk factors (such as a family history of cancer) for future illness.

Examples include:

  • AIDS patients not taking their lifesaving drugs.
  • People with diabetes becoming discouraged over difficulties with blood-sugar control.
  • Obese people ashamed to go out of doors and get the exercise they desperately need.
  • People with urinary incontinence afraid to leave their homes.
  • Unnecessary suffering in people with treatable mental illnesses.

Duke University researcher Laura Smart Richman, PhD, studies emotional influences on health.

"Shame is one reason why people don't seek care," Richman tells WebMD. "There tends to be this perspective that people should have a lot of control over their health -- even with an illness like cancer. We're told, 'You should think positive, you should eat the right foods.' So when people aren't healthy there is self-blame and the perception of societal blame."

Taking personal responsibility for one's life is a good thing. We all want to be independent and in control of our lives. But illness isn't something we fully control. That can be scary -- and shaming.

"People want to think, 'I am in control,' so if you have alcoholism, addiction, eating disorders, incontinence, whatever, there is shame in lack of self-control," Josephs says. "Shame can be dangerous if it keeps you from seeking help for anything serious. It is very upsetting to have a heart attack scare or a cancer scare. It is tempting to deny it -- because that is a big assault on our self-image."

This isn't merely a matter of vanity, or even of being a control freak. Shame is hardwired into our mental makeup, says psychiatrist Michelle E. Friedman, MD, director of pastoral counseling at Yeshivat Chovevei Torah rabbinical seminary and assistant clinical professor at Mount Sinai School of Medicine, New York.

"This is an issue and a struggle for every ill person," Friedman tells WebMD. "Shame comes from an ancient, primitive way of thinking. It is really powerful."

We feel guilty for what we do. We feel shame for what we are. A person feels guilt because he did something wrong. A person feels shame because he is something wrong. We may feel guilty because we lied to our mother. We may feel shame because we are not the person our mother wanted us to be. -- Lewis B. Smedes, U.S. psychologist

Why is shame such a problem? It has to do with the nature of this mixed emotion. Like its sister emotion, guilt, shame is what psychologists call a negative emotion.